小骨窗显微手术治疗基底节区高血压脑出血的效果分析及对血清CCCK-18、CTRP-3水平的影响

目的:探讨小骨窗显微手术治疗基底节区高血压脑出血的效果及对血清gaspase切割的细胞角蛋白18(CCCK-18)、补体C1q肿瘤坏死因子相关蛋白3(CTRP-3)水平的影响。方法:选取2016年5月至2018年5月我院收治的160例基底节区高血压脑出血患者,按照随机数表法将其分为观察组(n=82)和对照组(n=78)。对照组采用传统大骨瓣开颅术治疗,观察组采用小骨窗显微手术治疗。观察和比较两组的临床疗效,血肿清除率、术中出血量、术后意识恢复时间、住院时间,治疗前后NIHSS、ADL评分、血清CCCK-18、CTRP-3水平的变化及并发症的发生情况。结果:治疗后,观察组总有效率显著高于对照组[95.12%vs. 79.48%](P0.05);血肿清除率、术中出血量、术后意识恢复时间、住院时间均显著优于对照组[(93.62±3.58)%vs.(85.40±2.19)%,(92.47±12.56)mL vs.(189.25±26.47) mL,(2.01±0.58) d vs.(8.69±2.03) d,(13.39±2.08) d vs.(19.45±3.76) d](P0.05);NIHSS评分显著低于对照组[(9.76±1.42)分vs.(20.57±3.26)分](P0.05);ADL评分显著高于对照组[(86.42±8.64)分vs.(75.39±7.02)分](P0.05);血清CCCK-18水平显著低于对照组[(201.76±32.59) U/L vs.(237.57±39.20) U/L,(29.59±5.19) ng/mL vs.(42.97±7.94)ng/mL](P0.05);CTRP-3水平显著高于对照组[(289.59±35.19)ng/mL vs.(232.97±27.94)ng/mL](P0.05);并发症总发生率显著低于对照组[3.65%(3/82) vs. 14.10%(11/78)](P0.05)。结论:小骨窗显微手术治疗基底节区高血压脑出血的疗效显著,可更有效清除血肿,缓解血肿压迫,改善神经功能,减少继发性损伤,安全性高,可能与其降低血清CCCK-18水平及升高CTRP-3水平有关。     

髓内固定对老年股骨转子间骨折患者关节功能的影响

摘要 目的：研究髓内固定对老年股骨转子间骨折患者关节功能的影响。方法：选取2016年9月~2019年9月我院收治的股骨转子间骨折的老年患者80例为研究对象,采用随机数字表法将其分为两组,每组各40例。对照组患者采用Gamma钉进行治疗,观察组患者采用股骨近端防旋髓内钉固定治疗。比较两组患者的围术期相关指标、骨折愈合时间、Harris评分、临床治疗效果及并发症的发生情况。结果：观察组患者的手术时间、切口长度、术中出血量、术后引流量、住院时间及骨折愈合时间均显著少于或短于对照组(P＜0.05)。术前,两组患者的Harris评分比较无统计学差异(P＞0.05);术后6个月及术后12个月,两组患者的Harris评分均较术前显著升高,且观察组显著高于对照组(P＜0.05)。观察组患者的治疗优良率为92.50 %,显著高于对照组(75.00 %,P＜0.05)。两组患者深静脉血栓、感染、褥疮、固定松动、股骨头坏死及严重疼痛的发生率比较无统计学差异(P＞0.05)。结论：股骨近端防旋髓内钉固定治疗老年股骨转子间骨折效果明显优于Gamma钉治疗,可有效缩短骨折愈合时间,提高髋关节功能。     

Development of a 3D Tissue‐Engineered Skeletal Muscle and Bone Co‐culture System

In vitro 3D tissue‐engineered (TE) structures have been shown to better represent in vivo tissue morphology and biochemical pathways than monolayer culture, and are less ethically questionable than animal models. However, to create systems with even greater relevance, multiple integrated tissue systems should be recreated in vitro. In the present study, the effects and conditions most suitable for the co‐culture of TE skeletal muscle and bone are investigated. High‐glucose Dulbecco's modified Eagle medium (HG‐DMEM) supplemented with 20% fetal bovine serum followed by HG‐DMEM with 2% horse serum is found to enable proliferation of both C2C12 muscle precursor cells and TE85 human osteosarcoma cells, fusion of C2C12s into myotubes, as well as an upregulation of RUNX2/CBFa1 in TE85s. Myotube formation is also evident within indirect contact monolayer cultures. Finally, in 3D co‐cultures, TE85 collagen/hydroxyapatite constructs have significantly greater expression of RUNX2/CBFa1 and osteocalcin/BGLAP in the presence of collagen‐based C2C12 skeletal muscle constructs; however, fusion within these constructs appears reduced. This work demonstrates the first report of the simultaneous co‐culture and differentiation of 3D TE skeletal muscle and bone, and represents a significant step toward a full in vitro 3D musculoskeletal junction model.     

Isolation and characterization of mesenchymal stem cells in orthopaedics and the emergence of compact bone mesenchymal stem cells as a promising surgical adjunct

The potential clinical and economic impact of mesenchymal stem cell (MSC) therapy is immense. MSCs act through multiple pathways: (1) as “trophic” cells, secreting various factors that are immunomodulatory, anti-inflammatory, anti-apoptotic, proangiogenic, proliferative, and chemoattractive; (2) in conjunction with cells native to the tissue they reside in to enhance differentiation of surrounding cells to facilitate tissue regrowth. Researchers have developed methods for the extraction and expansion of MSCs from animal and human tissues. While many sources of MSCs exist, including adipose tissue and iliac crest bone graft, compact bone (CB) MSCs have shown great potential for use in orthopaedic surgery. CB MSCs exert powerful immunomodulatory effects in addition to demonstrating excellent regenerative capacity for use in filling boney defects. CB MSCs have been shown to have enhanced response to hypoxic conditions when compared with other forms of MSCs. More work is needed to continue to characterize the potential applications for CB MSCs in orthopaedic trauma.     

Stromal cell‐derived factor‐1/Exendin‐4 cotherapy facilitates the proliferation,migration and osteogenic differentiation of human periodontal ligament stem cells in vitro and promotes periodontal bone regeneration in vivo

ObjectivesStromal cell‐derived factor‐1 (SDF‐1) actively directs endogenous cell homing. Exendin‐4 (EX‐4) promotes stem cell osteogenic differentiation. Studies revealed that EX‐4 strengthened SDF‐1‐mediated stem cell migration. However, the effects of SDF‐1 and EX‐4 on periodontal ligament stem cells (PDLSCs) and bone regeneration have not been investigated. In this study, we aimed to evaluate the effects of SDF‐1/EX‐4 cotherapy on PDLSCs in vitro and periodontal bone regeneration in vivo.MethodsCell‐counting kit‐8 (CCK8), transwell assay, qRT‐PCR and western blot were used to determine the effects and mechanism of SDF‐1/EX‐4 cotherapy on PDLSCs in vitro. A rat periodontal bone defect model was developed to evaluate the effects of topical application of SDF‐1 and systemic injection of EX‐4 on endogenous cell recruitment, osteoclastogenesis and bone regeneration in vivo.ResultsSDF‐1/EX‐4 cotherapy had additive effects on PDLSC proliferation, migration, alkaline phosphatase (ALP) activity, mineral deposition and osteogenesis‐related gene expression compared to SDF‐1 or EX‐4 in vitro. Pretreatment with ERK inhibitor U0126 blocked SDF‐1/EX‐4 cotherapy induced ERK signal activation and PDLSC proliferation. SDF‐1/EX‐4 cotherapy significantly promoted new bone formation, recruited more CXCR4⁺ cells and CD90⁺/CD34^‐ stromal cells to the defects, enhanced early‐stage osteoclastogenesis and osteogenesis‐related markers expression in regenerated bone compared to control, SDF‐1 or EX‐4 in vivo.ConclusionsSDF‐1/EX‐4 cotherapy synergistically regulated PDLSC activities, promoted periodontal bone formation, thereby providing a new strategy for periodontal bone regeneration.     

NLRP3 regulates alveolar bone loss in ligature‐induced periodontitis by promoting osteoclastic differentiation

ObjectivesNLRP3 inflammasome is a critical part of the innate immune system and plays an important role in a variety of inflammatory diseases. However, the effects of NLRP3 inflammasome on periodontitis have not been fully studied.Materials and methodsWe used ligature‐induced periodontitis models of NLRP3 knockout mice (NLRP3^KO) and their wildtype (WT) littermates to compare their alveolar bone phenotypes. We further used Lysm‐Cre/Rosa^nTnG mouse to trace the changes of Lysm‐Cre⁺ osteoclast precursors in ligature‐induced periodontitis with or without MCC950 treatment. At last, we explored MCC950 as a potential drug for the treatment of periodontitis in vivo and in vitro.ResultsHere, we showed that the number of osteoclast precursors, osteoclast differentiation and alveolar bone loss were reduced in NLRP3^KO mice compared with WT littermates, by using ligature‐induced periodontitis model. Next, MCC950, a specific inhibitor of the NLRP3 inflammasome, was used to inhibit osteoclast precursors differentiation into osteoclast. Further, we used Lysm‐Cre/Rosa^nTnG mice to demonstrate that MCC950 decreases the number of Lysm‐Cre⁺ osteoclast precursors in ligature‐induced periodontitis. At last, treatment with MCC950 significantly suppressed alveolar bone loss with reduced IL‐1β activation and osteoclast differentiation in ligature‐induced periodontitis.ConclusionOur findings reveal that NLRP3 regulates alveolar bone loss in ligature‐induced periodontitis by promoting osteoclastic differentiation.